|
EST PT HCY AGE 5 - 11
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
9299393
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
EST PT HCY AGE 5 - 11
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
9499393
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
EST PT HCY AGE 5-11
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
5499393
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
EST PT HCY AGE 5-11
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
5499393
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$130.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$157.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT HCY AGE 5-11
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
4199393
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$130.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$157.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT HCY AGE 5-11
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
4199393
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
EST PT HCY AGE 65 AND UP
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5499397
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$297.00
|
|
|
EST PT HCY AGE 65 AND UP
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5499397
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$195.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$235.62
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$220.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT HCY NEWBORN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
9499391
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$184.50
|
|
|
EST PT HCY NEWBORN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
4199391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$121.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$146.37
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT HCY NEWBORN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
4199391
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$184.50
|
|
|
EST PT HCY NEWBORN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
9899391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$121.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$146.37
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT HCY NEWBORN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
9899391
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$184.50
|
|
|
EST PT HCY NEWBORN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
9299391
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$184.50
|
|
|
EST PT HCY NEWBORN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
9299391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$121.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$146.37
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT HCY NEWBORN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
9499391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$121.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$146.37
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT NH VISIT DISCHARGE <30 MIN
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9299315
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$112.50
|
|
|
EST PT NH VISIT DISCHARGE <30 MIN
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9299315
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$74.00
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$89.25
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT NH VISIT DISCHARGE <30 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9499315
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$148.50
|
|
|
EST PT NH VISIT DISCHARGE <30 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9499315
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$97.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$117.81
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT NH VISIT DISCHARGE >30 MIN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9299316
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$139.50
|
|
|
EST PT NH VISIT DISCHARGE >30 MIN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9299316
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.76 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$91.76
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$110.67
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT NH VISIT DISCHARGE >30 MIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9499316
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
EST PT NH VISIT DISCHARGE >30 MIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9499316
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$130.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$157.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
EST PT NH VISIT LEVEL 1
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
9499307
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$85.50
|
|
